Is paranoia increasing?

Daniel Freeman, Jason Freeman

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The urban nightmare

We’re living through a momentous shift in the development of the human race (Brockerhoff, 2000). For the first time in our 200,000-year history, half of humanity now lives in urban areas. There are now more than 90 cities with populations in excess of three million and 19 so-called ‘megacities’ with more than 10 million residents. Two thousand years ago, when the world population was around 200 million, there were only 40 cities with more than 50,000 inhabitants. The overwhelming majority of the population lived in rural communities. Although industrialisation, imperialism and other changes began a slow migration to cities in the 18th century, in 1800 only 5 per cent of the world’s population lived in urban areas. By 2030 that figure is likely to rise to something like 65 per cent. As the epidemiologist Tony McMichael (2000) has commented: ‘This ongoing move from countryside to city is as momentous a change in human ecology as was the ancient move from hunter-gatherer itineracy to agrarian settlement.’
One interesting consequence of this increase in urbanisation may be an increase in paranoia. An impressively consistent literature now shows that the occurrence of psychosis increases in urban environments (e.g. Kirkbride et al., 2006; Marcelis et al, 1998; Sundquist et al., 2004; van Os, 2001). For example, a 2004 survey of all Swedes between the ages of 25 and 64 (4.4 million people) revealed that people living in the most densely populated parts of the country had almost twice the rate of psychosis of those in the least populated areas (Sundquist et al., 2004). When researchers have looked at the spectrum of psychotic experiences, the findings are remarkably similar. A study of 7000 people in the Netherlands, for example, found that people in the most urbanised areas were twice as likely to report occasional mild hallucinations and delusions as people in the least populous parts of the country (van Os et al., 2001). If we’re more likely to suffer paranoid thinking in cities, it seems almost inevitable that the current rapid growth in urbanisation will bring with it an increase in rates of paranoia. An increasingly urbanised population is likely to be an increasingly paranoid one.
This connection between living in cities and paranoia also ties in with emerging psychological research. There is beginning to be a convergence in evidence (e.g. Bentall et al, 2008; Freeman et al, 2008a) that paranoia arises from an interaction of affective processes (especially anxiety, depression, worry and interpersonal sensitivity), anomalous experiences (such as hallucinations and perceptual anomalies), and reasoning biases (particularly jumping to conclusions, and belief inflexibility). The Camberwell Walk Study indicates that urban environments have an impact on several of these factors (Ellett et al., 2008). Fifteen patients with persecutory delusions were asked to walk down the Camberwell Road from the Institute of Psychiatry, buy a newspaper, and come back. Afterwards they were given a range of psychological tests. Their test scores were compared with those of 15 patients, again all with pronounced paranoia, who’d simply stayed at the Institute listening to a relaxation tape. In many ways Camberwell is typical of inner-city London: built-up, busy, and ethnically very diverse. It’s also an area of considerable poverty. Compared with relaxation, walking in this environment made patients think more negatively in general about themselves and other people and increased the jumping-to-conclusions reasoning bias. This kind of innovative experimental study adds an important link in the connection between urbanicity and paranoid thinking.

Other factors

Urbanisation isn’t, however, the only social factor that may be contributing to an increase in paranoia. We might add to this, for example, an increasingly flexible employment market, in which the idea of a job for life has long gone, replaced by much greater mobility of employees, and more reliance on short-term contracts and part-time positions on the part of employers. All of this breeds uncertainty, stress, and fuels competition in the workplace, encouraging us to see our colleagues as rivals and potential threats. We might also add to the list increasing levels of isolation, illicit drug use, wealth inequality, CCTV cameras…
In psychological research on psychosis a factor that has gained recent attention is trauma (see Morrison & Larkin, 2006). Study after study has shown that people who experience trauma (e.g. a serious illness, accident or assault, or the death of a loved one) are at greater risk of psychological problems, including paranoia. The same is true for people who’ve been victimised (e.g. suffering discrimination, bullying, or physical or sexual abuse). A British survey of 8000 people, for instance, found that people with a history of victimisation were twice as likely to suffer from paranoia (Johns et al., 2004). In one particularly compelling piece of research 2500 people aged between 14 and 24 in Germany were asked to describe any traumatic experiences they’d undergone in their lives. Follow-up interviews were carried out around three years later, from which it emerged that the young people who’d originally reported serious trauma were almost twice as likely to have gone on to develop psychosis as those who hadn’t experienced any trauma (Spauwen et al., 2006). This probably doesn’t come as a huge surprise to you. Being raped or bullied or violently mugged are not experiences one can take in one’s stride, and they aren’t likely to do much for our faith in other people either. After having suffered these kinds of trauma, paranoia can seem less a delusion than a reasonable viewpoint on the world.